Pharmacy Services

medical rxCenCal Health is committed to providing consistent, compassionate, and local support to all CenCal Health providers and members.

CenCal Health's Pharmacy Team is comprised of Pharmacist and Pharmacy Technician staff. Our Pharmacy Team is ready to assist our provider network and membership with pharmacy-related inquires and education. 

Medi-Cal Rx: Medi-Cal Pharmacy Benefit

Effective January 1, 2022, CenCal Health members will obtain their Medi-Cal pharmacy benefit through a new system. The Department of Health Care Services (DHCS) has given this new system the name, Medi-Cal Rx. Medi-Cal Rx will be administered through DHCS and its vendor, Magellan Medicaid Administration. Magellan will provide a comprehensive suite of administrative services as directed by DHCS, which include claims management/adjudication, prior authorization, utilization management, and customer/support. 

medi cal rx callMedi-Cal Rx is now responsible for administering the following when billed by a pharmacy on a pharmacy claim: 

  • Covered Outpatient Drugs, including Physician-Administered -Drugs (PADs)
  • Medical Supplies
  • Enteral Nutritional Products

Additional information regarding Medi-Cal Rx can be found in the "Medi-Cal Rx News" tab below and directly from the DHCS Medi-Cal Rx web site

For additional assistance contact Medi-Cal Rx Customer Service at: (800) 977-2273

You may also want to visit the Medi-Cal Rx Communication page for any upcoming bulletins and news.


CenCal Health Pharmacy Services: Medical Pharmacy Management

Effective January 1, 2022, CenCal Health and the Pharmacy Services Team will be responsible for a variety of activities including, but not limited to: oversight of clinical pharmacy adherence, Drug Utilization Review (DUR) and all utilization management associated with pharmacy services (Physician-Administered-Drug) billed on a medical and institutional claim. CenCal Health defines the utilization management of Physician-Administered-Drugs on the medical benefit as Medical Pharmacy Management. 

Additional information and education resources for CenCal Health's Medical Pharmacy Management Program can be found on our Medical Pharmacy Management page.

Continuous Glucose Monitors (CGM)

Medi-Cal Rx Benefit Update

Continuous Glucose Monitors (CGM)

Effective, January 1, 2022: New or expired TAR requests for Therapeutic CGM (DexCom or Libre) are now the responsibility of Medi-Cal Rx and ordering providers should no longer submit TAR requests for K0553 or K0554 to CenCal Health. Please submit Prior Authorization (PA) for the therapeutic CGM product directly to Medi-Cal Rx. 

In an effort to minimize member and provider disruption, existing, active TAR requests for K0553 and K0554 will be honored by CenCal Health through June 30, 2022. 

After June 30, 2022 a new Prior Authorization (PA) submission to Medi-Cal Rx will be required for coverage consideration. 

For inquires regarding an existing CGM CenCal Health TAR please contact CenCal Health Medical Management: (805) 562-1082.

For inquires regarding Medi-Cal Rx Prior Authorization process and/or CGM criteria please contact Medi-Cal Rx: 1-(805) 977-2273 or visit https://medi-calrx.dhcs.ca.gov/home/

CenCal Health Pharmacy Department is also available to assist with any Medi-Cal Rx inquires at: (805) 562-1080

 

 


















































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































































Medi-Cal Rx 2022

Medi-Cal Rx Support Services

The following document will provide the processing information for Medi-Cal Rx (i.e. BIN, PCN & Group) and additional payer information. 

Medi-Cal Rx Support Services and Key Payer Sheet Details


Pharmacies requesting additional operational claims support please contact:

Medi-Cal Rx Customer Service Center at: (800) 977-2273

 

 
















































































Pharmacy Network & Covered Drug List

Find a Pharmacy Search Tool

Pharmacy Search

Medi-Cal Rx Searchable Drug Lookup & Contract Drug List

Searchable Formulary

Medi-Cal Rx Contract Drug List 

See below for Pharmacy Service news.